Anaemia in CKD

Question 1

What is the main factor that contributes to people with CKD developing anaemia?

Answer 1

Reduced erythropoietin levels.

Question 2

What type of anaemia typically develops in someone with CKD?

Answer 2

Normochromic normocytic anaemia

Question 3

When does anaemia in CKD usually become apparent?

Answer 3

GFR is less than 35 ml/min

Question 4

What heart condition does anaemia in CKD predispose a person to?

Answer 4

Left ventricular hypertrophy

Question 5

What is the most significant cause of anaemia in CKD?

Answer 5

Reduced erythropoietin levels

Question 6

What are the other possible causes of anaemai in CKD?

Answer 6

reduced erythropoiesis due to toxic effects of uraemia on bone marrow
reduced absorption of iron
anorexia/nausea due to uraemia
reduced red cell survival (especially in haemodialysis)
blood loss due to capillary fragility and poor platelet function
stress ulceration leading to chronic blood loss

Question 7

What is the target haemoglobin for someone with anaemia in CKD?

Answer 7

10 - 12 g/dl

Question 8

What is the first thing to do if someone is presenting with anaemia in CKD before the administration of erythropoiesis-stimulating agents (ESA)?

Answer 8

Determination and optimisation of iron status

Question 9

What ESA’s can be given?

Answer 9

Erythropoietin
Darbepoetin

Question 10

What should be offered to those not on ESAs or haemodialysis?

Answer 10

Oral iron

Question 11

What should be given to patients on ESAs or haemodialysis?

Answer 11

IV iron

Question 12

What are the possible side effects of erythropoietin?

Answer 12

Aaccelerated hypertension potentially leading to encephalopathy and seizures
bone aches
flu-like symptoms
skin rashes, urticaria